Imagine having unfettered access to proven tools for choosing the right health plan, giving your partnership a competitive edge. A collaborative effort is already under way to do just that.
Health Rosetta has elevated its mission to provide a framework and ecosystem to
The aim is to share with benefit brokers and advisers battle-tested resources that transform group health plan norms in procurement, contracting and data use by 2030 to achieve superior clinical outcomes and lower costs 20% to 50%. Field guides have been developed to help industry producers seek out on behalf of their employer clients
Read more:
Mindful that employers lack north stars for prioritizing operational improvements to their health plans, NHI created shared standards of excellence that help HR and benefit professionals draft better requests for proposal (RFP) and vendor contracts, as well as measure return on investment.
While all 250-plus Health Rosetta advisers benefited from an earlier iteration of NHI resources, an open-source healthcare data platform now makes it accessible to any benefit broker or adviser across the industry. In addition, the National Alliance is using the NHI adviser RFP for 90 million employee lives in its ecosystem.
"Employers have the power to change much of their health plan," says Steve Ditto, an NHI board member who is leading the group's open-source PBM field guide project. "They can choose who they do business with, which will make them more compliant. And if they're more compliant, they're going to have better benefits at lower cost and more satisfied and healthier employees."
Read more:
While the services provided by PBMs, TPAs, stop-loss carriers and health insurers are interrelated, Ditto laments that each of their contracts use different definitions that easily can be exploited to increase profit and pit one vendor against another. In standardizing contracts, he says it's important to understand the process and workflow
He describes the PBM field guide as "essentially everything you would want to know about procuring that service and it's generally written at the level of an executive who has oversight responsibility."
It is supplemented by a series of other documents related to the procurement process that include a request-for-information template that lays the groundwork for an RFP highlighting contractual requirements that seek address gag clauses, rebate retention, spread pricing, underpaying local pharmacies, etc. Lastly, he says there's an actual contract with standard language and provisions that tie together all these pieces.
"Many brokers and advisers today think that the PBM business is complex and that they're not an expert in it," Ditto observes. "What we're trying to do through the field guide is cut through that complexity, simplify the process and really make it clear."
Read more:
The issue of overpaying for prescription drugs hit close to home for Ditto two years when he developed an autoimmune condition that required infusion treatments and landed him in intensive care. Following that episode, he was prescribed multiple drugs that cost about $1,000 a year amid nerve-racking lapses in coverage and the need for prior authorizations. But after becoming better educated about conflicts of interest between PBMs and big insurance carriers, he was able to find a price-transparency option that cut his cost by as much as 90%.
Kristine Scheer, founder and CEO of K2 Strategic and a Health Rosetta certified advisor since 2019, describes the NHI TPA RFP as a springboard to learning and phenomenal learning tool "for advisers who truly want to understand what drives cost, value and outcomes for their client partners and the integrity of the work that they do." It also provides tools and templates to help advisers differentiate themselves and become more successful in retaining and growing their business, she adds.
Noting how most RFPs appear in a Microsoft Word document, she created a template in Excel several years ago that has been updated periodically knowing that it's much easier to navigate side-by-side comparisons that way.
But upon acquiring a jumbo client earlier this year that needed some RFP work done for a medical TPA, she sought to build a new template that was bigger and better than the one her company created. Already familiar with the NHI resources that were available, she attended a webinar on their use, spoke with Health Rosetta co-founder Sean Schantzen and then began exporting and integrating that information from a spreadsheet format into her customized approach.
"It felt like it was very synergistic," she says.
